Chest Pain

Chest pain

Chest pain is a dull or sharp pain that lasts a couple of minutes to hours or months and may stem from different causes, but the most life-threatening one is a heart attack, a true medical emergency. 

Cardiac condition

If your chest pain is related to a heart condition, you may have

• Pressure and tightness in the chest.
• Crushing pain radiating to the jaw, neck, shoulders, back, and one or both arms.
• Pain that worsens with exertion and improves when resting.

If you develop chest pain that lasts longer than 5 minutes that does not go away after resting or taking medications, seek immediate medical attention. Chest pain from a cardiac cause is a life-threatening emergency. 

Other accompanied signs and symptoms are:

• Shortness of breath.
• Sweating.
• Nausea or vomiting.
• Dizziness and fainting
• Irregular heart rhythm, often rapid.

Causes

• Indigestion:  Burning sensation over the xiphoid process 
• Lung problems: Chest pain with difficulty breathing.  
• Musculoskeletal issues: Tender to touch.   
• Heart and vascular problems: 
• Aortic dissection is a tear in the wall of the aorta. It can feel like something is ripping in the chest, attended by intense pain in the chest, back, and between the shoulder blades. 
• Aortic aneurysm occurs when the wall of the aorta weakens and bulges out. The aneurysm wall can rupture, causing severe chest or abdominal pain. The condition is a bona fide medical emergency. 
• Coronary artery disease is due to cholesterol buildup blocking the blood vessels to the heart. The pain usually aggravates with physical exertion. 
• A heart attack occurs when your heart muscle dies due to an inadequate supply of oxygen which may result from a blockage in the coronary artery.
• Hypertrophic cardiomyopathy is the condition of a thickened and stiff muscular wall of the ventricle. The heart muscle is unable to get adequate oxygen-rich blood. 
• Pericarditis is an infection or inflammation of the enclosing fibrous sac around the heart. You can feel sharp chest pain with radiating pain to the left shoulder and arm. The pain typically worsens when lying down or inhaling.

Diagnosis

• Electrocardiogram (ECG or EKG)
• Blood tests measure the cardiac enzymes or cardiac biomarkers that are specific proteins in the heart muscle. If the protein is present in the blood, it can indicate you have ischemic heart disease. 
• Chest X-ray to display the size, shape, and condition of your heart, lungs, and blood vessels. It can show if you have a pulmonary embolism or pneumothorax.
• Echocardiograms to check your heart’s functional status.
• Computerized tomography (CT) scansto diagnose if you have a blood clot in the lung artery or aortic dissection.

Treatments

• Medications
• Surgery
  • Angioplasty and stent placement is a procedure to treatchest pain caused by a blocked coronary artery by inserting a catheter with an inflatable balloon and stent at its tip into an artery and threading it up to the blockage site. Inflate the balloon to widen the blocked artery and deflate it, then deploy the stent to prop up the blocked artery. 
  • Bypass surgeryuses a blood vessel from another part of the body to create an alternative route for the blood flow to your heart. 
  • Aortic dissection repairis an emergency surgical procedure to treat the separated layers of the aortic wall. 
  • Lung reflationis a treatment for pneumothorax by inserting a chest tube to reflate your lung.  
• Lifestyle modification
  • Exercise for at least 30 minutes a day.
  • Keep a healthy weight.
  • Stop smoking or using tobacco products. 
  • Eat a nutritious diet. Work with your doctor or dietitian to create a healthy diet plan. 
  • Keep your health conditions, such as diabetes, hypertension, and hyperlipidemia, under optimal control.